This competing continuation builds upon findings from our current study of treatment foster care (MH57448) to propose a randomized trial of enhanced long-term treatment foster care. Treatment foster care (TFC) is one of the only evidence-based residential treatment options for youth with mental health disorders and severe aggression. Previous randomized trials of TFC in model programs show that it can promote a range of positive outcomes (e.g., decreased problems and arrests, increased prosocial behavior and community tenure). Our current study, Therapeutic Foster Care in a System of Care, is built upon this research base to examine use, implementation, and outcomes of TFC in 'real-world' practice. Findings from this naturalistic study provide the impetus for the proposed competing continuation. Among other results, we found that TFC, as widely practiced, is often a relatively long-term treatment placement (mean length of stay was 22 months, and 46% of youth remained in TFC for longer than 24 months). This is in contrast to the short-term model (6-9 months) that has been the basis of existing research. Factors that drive outcomes in longer-term care appear to differ from those in short-term placement. Also, data suggest that several issues emerge during longer-term placements that require additional treatment foci to maximize the relevance and effectiveness of this approach. Building from the current evidence-based short-term model, our findings from 'real-world' practice, and additional promising practices, the proposed randomized trial will examine effectiveness of an enhanced model of long-term TFC for improving treatment and outcomes. A subset of agencies from the current study will be involved in implementing and evaluating this enhanced model. We will follow a sample of 300 youth and treatment parents (150 intervention, 150 control) for two years to assess implementation and outcomes. At present, TFC is widely regarded as an evidence-based treatment. The proposed study brings together the strengths of evidence-based treatment with the realities of practice to examine an improved approach to meeting the needs of youth in long-term TFC. Such information is crucial for maximizing the utility and effectiveness of TFC for some of the nation's most difficult to treat youth. [unreadable] [unreadable]